Provider Demographics
NPI:1124000286
Name:DR. STEVEN L. HEADRICK, P.C.
Entity type:Organization
Organization Name:DR. STEVEN L. HEADRICK, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEADRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DABCO
Authorized Official - Phone:605-997-3733
Mailing Address - Street 1:109 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:FLANDREAU
Mailing Address - State:SD
Mailing Address - Zip Code:57028-1222
Mailing Address - Country:US
Mailing Address - Phone:605-997-3733
Mailing Address - Fax:
Practice Address - Street 1:109 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:FLANDREAU
Practice Address - State:SD
Practice Address - Zip Code:57028-1222
Practice Address - Country:US
Practice Address - Phone:605-997-3733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD587111N00000X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7600752Medicaid
SD7600752Medicaid
T66521Medicare UPIN